ARV Therapy During Pandemic

KOMPAS/DEONISIA ARLINTA

Antiretroviral drug combination type TLE or tenofovir, lamivudine, and efavirenz. The Ministry of Health claims that the availability of this drug is safe until the end of 2019.

The human immunodeficiency virus (HIV) is still a major global public health issue that has claimed at least 36.3 million lives.

The virus causes acquired immunodeficiency syndrome (AIDS), which attacks the body’s immune system. People who have been infected with HIV are called “people living with HIV”, or PLHIV.

Data from the World Health Organization (WHO) show that 37.7 million people were living with HIV as of the end of 2020, with 1.5 million new infections per year. The fatality rate of HIV is 680,000 people per year.

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As of March 2021, the Health Ministry estimated that 543,100 people were living with HIV in Indonesia, including around 427,201 people (78.7 percent) who are aware of their HIV status. Of that figure, 144,632 people (26.6 percent) are receiving regular treatment and among these, the virus is no longer detectable in just 7.7 percent.

This achievement is far from the previous global target to achieve “90-90-90” by 2030. This means that by 2030, 90 percent of all people living with HIV know their HIV status, that 90 percent of these people is receiving antiretroviral (ARV) therapy, and 90 percent of all people receiving ARV therapy have virus suppression (undetectable viral load).

The new target is 95-95-95, as declared at the United Nations High Level Meeting on HIV/AIDS in June. To achieve this, stakeholders in Indonesia must work extra hard.

Until now, there is no cure for HIV. There are antiretroviral (ARV) drugs to prevent opportunistic infections and suppress the virus to reduce the risk of transmission. ARV drugs must be taken for life. If a person stops taking the drugs, the virus will start replicating again and potentially mutate into a strain that is resistant to ARV drugs.

Kompas

Francesca Nice, PHD Research Associate prepares blood samples from coronavirus patients for analysis as part of the TACTIC-R trial, in the Blood Processing Lab in the Cambridge Institute of Therapeutic Immunology and Infectious Disease, in Cambridge, England on May 21, 2020, during the novel coronavirus COVID-19 pandemic. - The new trial known as TACTIC-R is testing whether existing drugs will help prevent the body\'s immune system from overreacting, which scientists hope could prevent organ failure and death in COVID-19 patients.

In Indonesia, the government provides ARV drugs for free, while health examinations are covered by the Health Care and Social Security Agency (BPJS Kesehatan). During the pandemic, the mobility restrictions imposed to curb Covid-19 transmission and the shift in the public health service to focus on Covid-19 have disrupted HIV services. In addition, the operational hours for healthcare services have been cut, and field clinics have been temporarily suspended.

According to Health Ministry data, 72,133 PLHIVs stopped their ARV therapy in 2020. In addition to becoming tired of taking the drugs, known as treatment fatigue, many people experienced socioeconomic problems. The majority worked in the informal sector, at small companies or at beauty salons. The economic fallout from the pandemic severely impacted their incomes. Aside from being able to pay for their transportation to health facilities, it became difficult for them to meet their daily needs.

A breakthrough is needed so they are all issued ID cards and can therefore access health services and social assistance.

Social assistance is only given to people who have ID cards. In fact, most PLHIVs are from marginalized groups and do not have ID cards. They may “disappear” when working as sex workers or be disowned by their families. This is especially prevalent among transwomen and drug addicts. A breakthrough is needed so they are all issued ID cards and can therefore access health services and social assistance.

The WHO recommends providing enough ARV drugs to cover 3-6 months of the treatment schedule, so PLHIVs do not have to visit health facilities so frequently. The Health Ministry regulates a two-month distribution of the drugs, but the limited drug supply makes this impossible in many areas. Central and local governments need to ensure access to testing, consultation, and treatment for people living with HIV.

(This article was translated by Hendarsyah Tarmizi).